The Department of Emergency Medicine of Froedtert Hospital in collaboration with the Departments of Neurology and Neurosurgery at the Medical College of Wisconsin (MCW), and Children's Hospital of Wisconsin are submitting this application for consideration to continue as a Clinical Site Hub of the NINDS Emergencies Treatment Trials Network (NETT) to be known as the Milwaukee Clinical Site Hub (MCSH). The MCSH will be coordinated by Principal Investigator, Tom P. Aufderheide, MD, Professor of Emergency Medicine, Co-lnvestigator, John R. Lynch, MD, Director of the Neurology Critical Care Program and Neurointensive Care Unit, and Dennis J. Maiman, MD, PhD, Professor and Chair of the Department of Neurosurgery. Our blueprint capitalizes on MCW's enormous infrastructure as a major JCAHO-certified Regional Stroke Center and deploys a cadre of collaborative Centers and the MCW Clinical and Translational Science Institute of Southeast Wisconsin (CTSI). The Milwaukee County Emergency Medical Services System, implementing selected NETT protocols, is a national leader in out-of-hospital exception from informed consent clinical research and is directed from the MCSH. MCSH has significantly expanded its footprint to include three new Milwaukee Community Spokes (St. Luke's Medical Center, Columbia-St. Mary's Hospital, and Columbia-St. Mary's Hospital Ozaukee), all JCAHO-certified Stroke Centers, as well as three new Regional Spokes: 1) The University of Wisconsin Hospital, Madison, Wl, 2) Rush University Medical Center, Chicago, IL, and 3) Mercy Hospital, St. Louis, MO. The MCSH aims to: 1) Expand our Hub and Spoke footprint to capture a sizable population of ethnically diverse patients with neurological emergencies; 2) Utilize our previous successful NETT experience to provide leadership and research support to maximize the Hub's successful study implementation; 3) Capitalize on expanded research infrastructure to maximize efficiency of study implementation and patient capture, and 4) Orchestrate this collaborative network to meet or exceed NETT research and patient accrual goals during the next five years. PUBLIC HEALTH RELEVANCE: Approximately 15% of all emergency department encounters are neurological emergencies resulting in significant morbidity, mortality, and cost. The Milwaukee Clinical Site Hub will collaborate with the Neurological Emergencies Treatment Trials (NETT) Network to conduct large, simple multicenter clinical trials to achieve its mission of improving outcomes for patients with neurological emergencies.